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Today is stim day 12 of Lupron for my sixth IVF cycle. Above is the first picture of my baby girl, Harper Jean, who would have been born a year ago today. Today, I honor her memory and miss her so much. How I wish she would have made it. She is my angel baby. I do not think I will feel complete on a Christmas morning until I am holding a child in my arms….

Today started with my Lovenox injection, followed by a nice quiet breakfast with my entire family, except my brother in law who is in Iraq working. We then started opening gifts. My mom was blown away by her gifts: Burberry bag, Tiffany & Co. Holiday Mug, Ancestry.com DNa kit, UGG Australia shoes, Heated Blanket. My mom gave everyone Amazon.com giftcards. I gave my nieces and nephews giftcards to their favorite food places or stores, my sisters: one three designer sweaters, the other a velour leisure suit and a hooded top, my brother in law in Iraq: a Gucci wallet, my other brother in law: giftcard to his favorite store, my cousin: Visa giftcard, and my videographer: Amazon.com giftcard. I only purchased Christmas gifts for my Godmother and my best friend. Typically, I only buy gifts for friends who either buy me gifts or if they are having a party/event. I have too many friends, so I normally just bake something delicious and ship it to everyone else when I have time. I have to go out this weekend and get a giftcard for my doorman. I have a friend in the Bay Area who is having a birthday party again this year, so I got her a Tiffany & Co. Holiday mug. Every year, I normally just get her a new mug or wine glasses from Tiffany & Co. Who doesn’t like receiving a little blue box?

I went to Union Station this morning at 11 am and picked up Mark (videographer) and my cousin Chris, who lives in DC. Mark is going with my mom and I to the beach for a week and we will be filming segments for my reality show.

We are all chilling today at my sister’s house in Northern VA and may go out tonight to see Concussion at the theater. We leave at 3 am so I hope I have enough energy lol.

My brother in law grilled chicken wings, ribs, chopped chicken bbq, and my sister cooked a roast and a ham. We are also having mac n cheese, slow cooker collards, string beans, string bean casserole, sweet potato souffle, potato salad, peach cobbler and a whole bunch of other stuff my sister has whipped up. I cooked Thanksgiving Dinner and hosted at my condo at the beach and everyone came in, so I am chilling for Christmas AND Easter ! My other sister will be hosting Easter in North Carolina this year, unless we decide to take the family annual trip to Orlando at that time. Then she will have to cook there lol. I am retired until Thanksgiving ! I will definitely have my meal catered if I am blessed with my babies, because I will not feel up to cooking a spread after a c-section !

Tonight, I will be doing my Lupron injection and taking the LDN at 9pm. That is it for me…

I hope everyone is having a fantastic Christmas and I hope we all have babies en route in 2016 !!

Natural Killer Cells – A Reason Behind Recurrent Miscarriage?

Natural killer (NK) cells have an important role to play in the early response to viral infections, and have also been linked with failure of pregnancy.

Natural killer cell activity is now known to be a major cause of miscarriage and reduced implantation.

We also know that natural killer cell activity can be mediated by high levels of stress as well as auto immune disease.

Recent reports in the media and on the internet have exposed women to a baffling array of conflicting information about tests for NK cells and “cures” for infertility and miscarriage.

Increasingly, clinics are offering tests to measure the number and activity of circulating NK cells.

As a result of these investigations, many women are offered treatments such as steroids, intravenous immunoglobulins, and tumour necrosis factor blocking agents.

Natural killer cells (identified by the surface marker CD56) are the dominant type of maternal immune cells populating the uterine mucosa during formation of the placenta. These uterine NK cells are also present in the endometrium (uterine lining) of non-pregnant women, when they are under the control of ovarian hormones. After ovulation, uterine NK cells increase vigorously so that by the late secretory phase they account for at least 30% of the endometrial stroma.

Uterine NK cells accumulate in large numbers at the implantation site. Here they are in close contact with the invading placental trophoblast cells, which transform the spiral arteries into high conductance vessels. This transformation is essential to ensure a normal blood supply to the fetus and placenta throughout pregnancy. Something important to note is that there is a huge difference between uterine NK cells and the NK cells that circulate in the blood stream, causing miscarriage. The best way to explain the difference between uterine killer cells and NK cells circulating in the peripheral blood stream is to show what happens to them in the body. Basically, uterine NK cells grow in large number to protect an embryo and ensure its development. They are there to attack anything that may try and harm the embryo, such as viruses. So, What Causes The Problem? Here’s the problem: if there is any inflammation in the pelvic cavity or the endometrial lining (endometriosis, PCOS, tubal inflammation etc.), the immune system responds by sending down the other NK cells in the blood stream to attack and kill off inflammation. Remember, NK cells are designed to be in the body and are very important in our protection of viruses and cancer cells. When these NK cells in the blood stream (not uterine NK cells) reach the site of inflammation in the uterus or pelvic cavity, the uterine killer cells that are protecting the embryo move out of the way to let the NK cells do their work. Unfortunately, sometimes an embryo is recognised as a foreign organism and is attacked and killed off.

This is where the issues surrounding recurrent miscarriage come in. This is also a reason why any inflammation in the uterus or pelvic cavity needs to be addressed to help fix this issue, and one of the reasons why any woman having fertility issues needs to have a laparoscopy prior to any further fertility treatment. A laparoscopy is the gold standard for addressing and treatment of issues in the uterine and pelvic cavity. As mentioned earlier, these naturally occurring immune mediated cells can occur due to an overactive immune system and inflammation in the body. This is why immune disorders such as thyroid issues need to be screened as well. When screening for thyroid issues, it is important not to just screen for TSH (Thyroid Stimulating Hormone) levels but to also screen free T3 and T4 levels, and more importantly to screen for thyroid antibodies. Many women with the beginnings of thyroid disease can have normal TSH levels but can have very high antibody levels. In order to get a diagnosis of high levels of NK cell activity in the uterus, a biopsy needs to be undertaken between day 24 and day 28 of a menstrual cycle. This is because NK cells are at their highest levels during this phase of the menstrual cycle. The procedure only needs to be done in a doctor’s room and does not require anaesthetic. Most women say the test feels similar to having a pap smear. Unfortunately, this procedure is invasive and inconvenient, but it’s not possible to be done during an IVF cycle. Once the biopsy is done, the small amount of endometrial tissue is sent away for genetic testing and the results take two weeks to process. Most of the testing done in Australia has to be sent to Sydney, as there is really only one lab doing proper testing. Many specialists in Australia fail to test for this, and it’s astounding given that it’s a very simple testing procedure that can offer great results, treatment and answers to those who have been enduring the heartache of miscarriage with no explanation. In Sydney, most of the testing and screening is done through several specialists at IVF Australia, and in Brisbane, there is really only one specialist screening and treating for NK cells.

Treatment for Natural Killer Cells There is really only one treatment in western medicine for NK cells, and it involves the use of steroids at pre and post conception. Prednisone is the main steroid used and is given in a dosage anywhere from 10mg-20mgs daily. However, steroids can have major side effects on the mother and unborn child. Steroids also suppress the whole immune system and dampen down killer cell activity this way. This also leaves the mother more prone to infections, colds and flu and other immune disorders. The key is regulating the amount of killer cells rather than using blanket suppression approach. But to date, this is all western medicine has. Australia is the leader in NK research with regards to fertility, and most of the work is being done by Dr Gavin Sacks at IVF Australia. The great news is that we have access to some fantastic natural products that can help with reducing inflammation and regulating NK cells. At my clinic, we have seen great results from our patients who are using these natural anti-inflammatory products. They are taken while trying to conceive and during pregnancy, with absolutely no side effects or harm to the pregnancy. We also have an effective herbal formula that we recommend to everyone for colds or flus, which can be taken for immune support and as a preventative. It dampens down inflammation and helps to regulate NK cell activity. We’ve started to recommend this treatment to all fertility clients, in case of the presence of undiagnosed Natural Killer cells. There are also Chinese herbs that can regulate natural killer cells. The ConceptShen Nutritional Medicine formula called ‘Nourish’ helps with inflammation and NK cell regulation. Its major function is to prevent miscarriage and also increase circulation into the uterine lining to assist implantation. Natural Killer cells can be present in unexplained infertility and may be more prevalent in those with autoimmune disease or other inflammatory conditions such as endometriosis, tubal disease and PCOS (polycystic ovarian syndrome). In my clinic, I screen my fertility patients for NK cells, especially those who have had recurrent miscarriage, because I believe it should be an initial investigation to save couples the heartache of going through a miscarriage, especially if Natural Killer cells may be the cause.

** The supplement, EPA with DHA is AWESOME for decreasing the activity of NK cells. I ordered mine from Amazon.com

Helping Someone After a Miscarriage

When we offer help to someone through this time, they are often in such shock they don’t know what they need. The objectives are to encourage the venting of their grief and re-establishing their self-esteem while recognizing their sorrow. Whatever the person is feeling, they deserve to have their feelings supported by the people around them. If you are their main comforter, see the following website for suggestions on how to be the most useful companion to a grieving person; www.centerforloss.com/companioning-philosophy.

Do’s

Contact is important. Be there if possible, but if not ring. A card would be lovely. Texting, Email or Facebook can feel less personal.

Whatever she is feeling, she deserves to have her feelings supported by people around her.

A hug or arm around her shoulders is comforting.

Understand that her tears are a healthy response and should never be discouraged. Having a box of tissues handy is helpful.

Let her do the talking. Be the passive partner who asks questions and focus on certain points to help her talk about her feelings. It is sufficient to just listen.

Tell her how you feel about her losing the baby and how sorry you are.

Acknowledge her pain even if you think you would not react this way in this situation.

Ask questions about her experience, how she is really feeling and what she is thinking about.

When you ask her partner how she is doing, don’t forget to ask him how he is.

Encourage her to be patient and not to impose ‘shoulds’ on herself – grieving takes time

Reassure her she did everything she could and it wasn’t her fault – it helps alleviate guilt.

Grieving is a physically exhausting process and she will probably need to sleep or rest during the day. Take whatever steps necessary to give her the uninterrupted peace to do this.

The intensity of grief fluctuates. During less tearful times a change of scenery is appreciated.

Do something practical such as hanging up the washing/shopping or offer to take around a meal.

Put on soothing music for her to listen to, offer a back massage, a walk on the beach. When she feels ready, take her to a movie of her choice.

If you are seriously worried about her behavior, seek professional advice. As a rule of thumb, as long as she is not damaging herself, another person or property, you probably don’t have anything to worry about.

Don’ts

Don’t ignore her because you feel helpless or uncomfortable with grief – she will wonder if what happened to her means nothing to you.

Don’t think that miscarriage is easier to cope with than a stillbirth or neonatal death. The truth is that her baby has just died, and it doesn’t really matter how pregnant she was.

Don’t be anxious or embarrassed about making her cry. It is not what you said or did that upset her, but losing the baby. By allowing her to cry, you are helping her work through the process of grief.

Don’t confuse support with “cheering her up”. Grief is an enormously powerful emotion and needs releasing, not repressing.

Don’t put on a bright cheery front yourself.

Don’t be nervous and keep talking. There is nothing wrong with silence. You can share silence with a good friend.

Don’t be tempted to be judgmental in any way about her feelings or reactions. People in grief often behave out of character or inappropriately and need your unconditional support. Things will eventually return to normal and she will feel grateful that you stood by her.

Don’t have expectations about how long it should take her to recover. Losing a baby is one of life’s most difficult experiences and the depth of her grief is shocking even to her.

Don’t assume there will be another pregnancy.

Don’t try to do all the housework. Although well intentioned, she needs to feel capable and useful.

Don’t minimize her loss by offering platitudes such as “you’re young enough to try again”, or “it was nature’s way of getting rid of an imperfect baby”. It is appropriate to deal with this as you would any other death.

Don’t say that “she’s so lucky to have the other kids” – her pain is for this baby and other children don’t take that away.

Don’t forget her children have lost a sibling, and it is natural for them to react in some way.

Don’t feel guilty if you’re pregnant. Just forgive her if she’s cold and withdrawn, it’s her way of coping.

Don’t feel you have to keep your children away. She must go through the process of accepting others’ children.

Don’t ask how she is feeling if you only do so as a social obligation as it obliges you to listen carefully to the complete answer.

Seven helpful things to say

“I’m so sorry about your Miscarriage.” These simple words mean a lot, especially if you allow the Mum or Dad to talk further, or not to talk, as they wish.

“I know how much you wanted that baby.” Here you are simply acknowledging that something precious has been lost, and opening a door to talk more.

“It’s okay to cry.” – this can sound like Hollywood but it’s reassuring for the Mum or Dad to know they are not being judged for their tears and sadness.

“Can I call you back next week to see how you are doing?” Often people are sympathetic the first time, then never mention miscarriage again. You can expect the parents to still be grieving for weeks or months, so it is reassuring for them to know your support is ongoing.

“I was wondering how you are feeling about your miscarriage now” – it’s nice for them to have the opportunity to talk about their miscarriage even if it is a long time later and after a successful pregnancy as well. Parents do not forget a miscarriage.

“I don’t really know what to say.” The good thing about this is that it is honest. The fact that you are available to listen is what’s really important.

“It must be so awful for you after going through those weeks of IVF treatment to have lost your baby.”

Seven things not to say

“You can always have another one” – it doesn’t help much to know you can have another baby. The parents didn’t just want any baby, they wanted THAT baby. Before they can think about another one they need to grieve for their lost one. They have lost their hopes and dreams as well.

“There was probably something wrong with it – it’s natures way.” This may be true but it is no comfort to hear it. They want to believe it was a perfect baby, and that’s who they are grieving for.

“It’s God’s will” – People may or may not believe this. Whatever the case, it’s still sad. You are better supporting the parents’ grief than getting into theology.

“At least you didn’t know the baby – it would have been much worse if it had happened later” – it does not help to minimize and invalidate a miscarriage, it is not the length of the pregnancy, but the strength of the parents’ attachment, that determines the intensity of their grief.

“I know how you feel” – this statement can seem arrogant, even if you have miscarried yourself, as everyone reacts differently. Other losses can compound grief.

“It wasn’t really a baby yet” – that may not be how the parents see it. If it wasn’t a baby what was it? To them it was real and they are grieving.

“You’re young, there’s plenty of time. If you’d stop focusing on being pregnant so much it will just happen”

If in doubt, say something – anything – and be prepared to listen. Possibly the hardest thing, even harder than hearing an insensitive comment, is when people say nothing at all.
(The Seven helpful things to say and Seven things not to say lists are compiled from information courtesy of the Wellington Miscarriage Group)

exercise (lowers risk of miscarriage of a healthy fetus by 40%; however, there are opposing studies)

Studies show the overall risk of miscarriage to be around 20%. Once a gestational sac has been observed, the chance of miscarriage decreases to around 13.5%. After a heartbeat is seen, the odds improve even further, and the chance of miscarriage decreases to 9.4% at 6 weeks and a mere 0.5% at 9 weeks.

However, miscarriage continues to affect many women, and so there has been considerable research regarding the particular causes. What causes miscarriage remains unclear and certainly much is left to be elucidated. That being said, here are some findings regarding the most common causes of miscarriage:

Chromosomal abnormalities: The most common cause of miscarriage seems to be a failure in cellular division which results in an abnormal number of chromosomes. This has been estimated to cause up to 80% of miscarriages. Although it has been assumed by some that there is little that can be done to prevent these miscarriages, certain factors increase one’s odds of having a chromosomal defect. Smoking and low levels of folate in both mother and father have been associated with a higher risk of chromosomal defects. Thus, elimination of smoking and supplementation of folic acid may reduce one’s risk of miscarriage from these causes. Also, an acidic PH level causes chromosomal defects in mice, so it could be postulated that adopting an alkaline diet might reduce the chances of miscarriage. Another factor may be the time to fertilization after ovulation. In hamsters, mating too late after ovulation results in higher rates of aneuploidy and triploidy, which causes miscarriage. Finally, although maternal age has been associated with chromosomal abnormalities, recent research has suggested that it is actually high levels of FSH resulting from a reduced egg supply that is the culprit and may cause miscarriage. Thus natural methods of reducing FSH, such as increasing dietary fiber intake, or consuming soy or vitex may be helpful in preventing miscarriage.

Thrombophilia: Of the known medical causes of miscarriage, thrombophilia is among the most common. In women with no physical, hormonal or chromosomal abnormalities, 92% have been found to have thrombophilia. Once thrombophilia has been identified by a doctor, the prescription medication heparin has been shown to reduce the chances of miscarriage in women with thrombophilia to that of healthy controls. To prevent hypercoagulation, reducing dietary fat, stress, and high BMI may be of some help.

Progesterone: Luteal phase defect is found in up to 35% of women with repeat miscarriage. Inadequate progesterone production is thought to be a contributing factor to luteal phase defect. Likewise, low progesterone may cause miscarriage. 91% of pregnancies with progesterone lower than 15 ng/ml end in miscarriage. Increasing progesterone may reduce one’s chances of miscarriage. In women with recurrent miscarriage, women who were given supplemental progesterone reduced their odds of miscarriage by 62% versus women who received placebo or no treatment. One may be able to increase their levels of progesterone naturally by supplementing with either vitamin C, vitamin E, L-arginine, beta carotene, vitamin B6, vitex, black cohosh (on cycle days 1 to 12) or selenium, as these have all shown positive results in various studies. Also, consuming dairy products, reducing obesity, avoiding overeating and saturated fat and improving insulin sensitivity have been shown beneficial to progesterone levels. Likewise, many of these solutions have been associated with a lower risk of miscarriage.

Diet: Avoiding poor dietary choices may be beneficial in avoiding miscarriage. While there have only been a handful of studies regarding which food choices influence one’s risk of miscarriage, the findings have been significant. One study found that those who consumed the most butter doubled their chances of miscarriage over those who consumed the least, even after adjusting for BMI. Likewise, those with the highest levels of oil consumption had a 60% higher chance of miscarriage. High levels of dietary fat may cause miscarriage because they cause higher levels of inflammation and blood coagulation, or because they deleteriously affect hormone production. For those wanting to avoid miscarriage, consuming fruit may be one of the most powerful tools easily available. Women with the highest level of fruit consumption reduced their chance of miscarriage by 70%. Similarly, women with the highest level of vegetable consumption had a 40% lower chance of miscarriage. While meat consumption per se does not seem to cause miscarriage, those who consumed the most fish reduced their chance of miscarriage by 30% and those who consumed the most eggs also reduced their risk of miscarriage by 30%. Consuming dairy products every day has been shown to reduce the odds of miscarriage by 33%. This may be due to dairy’s ability to reduce inflammation or increase levels of estrogen. Surprisingly, eating chocolate seems to reduce the odds of miscarriage by 19%.

New research indicates that women who become pregnant with donated eggs are more likely to suffer miscarriages and dangerous high blood pressure than those who undergo fertility treatments with their own eggs.

In a study presented Tuesday at the annual meeting of the European Society of Human Reproduction and Embryology, Korean scientists reported that the risk was even higher if the donated egg came from a woman who was not related to the patient.

Experts believe the greater risks are due to the fact that donated eggs, like transplanted organs or tissue, are not genetically identical to the recipient and probably awaken the immune system.

The placenta formed after egg donation may have more foreign elements and trigger abnormal responses from the mother, which could results in complications, such as miscarriages or high blood pressure.

Experts said the findings suggest that women who need donated eggs might be better off with eggs from a relative.

In the study, conducted by Dr. SunHwa Cha of Sungkyunkwan University School of Medicine in Seoul, South Korea, 61 pregnancies involving egg donation were compared with a matched group of pregnancies achieved through standard infertility treatment.

Pregnancy induced high blood pressure — which can become life-threatening to mother and baby — occurred in 12.5 percent of the women who got donated eggs and in 3.7 percent of the women who used their own eggs.

The problem was twice as likely to occur following egg donation from a sister, but more than five times as likely following egg donation from a stranger, the study found.